Newletter Masthead
September 2001 · Vol. 26, No. 3, pp. 5-6

AMA adopts new ethics principles

First change in 21 years

Howard Zonana MD, Medical Director

The American Medical Association annual meeting in Chicago continued its recent trend of combining scandal and political machinations along with its usual body of resolutions and scientific reports. The scandals keep flowing at a time that the organization's membership is in dire straits, as they now represent only a third or less of the physicians of this country. This time the relatively new executive vice-president, Dr. E. Ratcliffe Anderson Jr., hired after the "Sunbeam" episode, filed a lawsuit against the AMA. Anderson sued the AMA and its chairman, Dr. Timothy Flaherty, on June 18 as members met in Chicago for their annual meeting. Anderson alleges that the group did not allow him to fire the organization's top lawyer over a real estate sale because the attorney had protected certain trustees from being identified with an embarrassing 1997 endorsement deal with Sunbeam Corp. Anderson also alleges that Flaherty made disparaging comments about the CEO's compensation package of more than $500,000 a year. At the end of June the AMA fired Anderson, less than two weeks after he slapped the group and its chairman with a breach of contract and defamation lawsuit. Now, however, the AMA's troubles do not look as though they will subside anytime soon. Anderson vowed to forge ahead with his litigation.

All this of course raises interesting questions for our organization as we have been trying to gain a seat in the House of Delegates of the AMA. For some this may be further reason to avoid this organization fraught with major difficulties. For others it may allow some negotiating position for us to gain some membership advantages. I look forward to our annual meeting to continue the debate. Nonetheless, the AMA has passed a number of actions that affect all of us. First there has been a revision of the basic principles of Medical Ethics. The Principles now state:

I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.

II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.

IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.

V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.

VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.

VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

IX. A physician shall support access to medical care for all people.

The revised Principles of Medical Ethics now emphasize a physician's "responsibility to participate in activities contributing to the betterment of public health," and state that "a physician shall, while caring for a patient, regard responsibility to the patient as paramount," and that "a physician shall support access to medical care for all people."

. The revisions were brought to the House of Delegates at the 2000 Interim Meeting. The Council on Ethical and Judicial Affairs (CEJA) had been working on them for several years, soliciting comments from the Federation. There was general support for the existing principles, but delegates and the Federation looked to CEJA for additional guidance to reflect a changing practice environment. On Sunday, June 17 at the AMA Annual Meeting, the document physicians and others rely on to guide their physician's ethical conduct was changed for the first time in 21 years by a two-thirds majority vote of the AMA House of Delegates

The nine principles adopted by the AMA are not laws. Rather, they are standards of conduct - widely used by courts and medical boards - that define the essentials of honorable behavior for physicians, according to the Principles' Preamble. The principles also form the basis for opinions in the Code of Medical Ethics. The code, which dates to the AMA's founding in 1847, is also used as the basis for the American Psychiatric Association's ethical guidelines, which provide annotations with special reference for psychiatrists.

Death penalty issues

In other actions the House of Delegates modified a resolution introduced by the New York delegation calling for a moratorium on capital punishment similar in language to that recently adopted by both the APA and AAPL. After several hours of heated discussion at the reference committee they passed but modified the resolution to exclude the "moratorium" language. The House adopted this modified Resolution 8, which states the AMA does not take a position on capital punishment but urges legislative and legal authorities to change the system of administration of capital punishment, if used at all, and to promote its fair and impartial administration in accordance with due process.

On the amicus front AAPL has been attempting to be more involved in taking position on cases that relate to our work. AAPL joined an amicus brief on the Penry Case with both APAs. The US Supreme Court overturned the death sentence of a retarded Texas man, Johnny Paul Penry, who in 20 years on the state's death row has become a symbol of a growing national debate over executing the mentally retarded. Although the court did not directly address the broader issue of whether a mentally retarded person should be executed, the justices ruled 6 to 3 that jurors in Mr. Penry's case received flawed instructions about how they should consider his retardation. The ruling was the second time the court had set aside Mr. Penry's death sentence. In 1989, the court ruled that the Constitution permitted the execution of mentally retarded people, but it overturned Mr. Penry's sentence because jury instructions did not allow jurors to take his retardation sufficiently into account.

We had been concerned about the use of a prior competence to stand trial report from a different case that was introduced at the capital sentencing hearing because the evaluator had gratuitously included a comment that he thought he would be dangerous in the future. We argued that this was inappropriate. The Supreme Court thought this was not determinative of the outcome considering all of the other data and did not rule on the substantive question.

For its next term, beginning in October, the court has agreed to revisit the issue of whether the Constitution permits the execution of retarded inmates, in a case from North Carolina. We have also signed onto a brief in that case, McCarver v. North Carolina, No. 00- 8727.

In addition, the Court is hearing another Kansas case relating to sexual predators -In re Crane (269 Kan. 578). The question under discussion relates to whether the state must prove a volitional impairment or "lack of control" to make the statute constitutional. We hope to join the APA brief on this case as well.